Megan Williams
Cleveland Heights,OH
Summary
Experienced leader in Revenue Cycle Management. Skilled in team management and operations with a strong track record in optimizing billing processes and integrating AI technologies. Adept at cross-functional teamwork and relationship building. Committed to enhancing efficiency and supporting organizational growth.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Manager of Billing & Coding
Midwest Vision Partners
07.2023 - Current
- Manages daily operations of the RCM Audit, Billing and Charge Entry teams handling both medical/surgical and vision professional and Ambulatory Surgical Center billings and charges.
- Mentors and trains new employees on departmental functions.
- Currently manages a team of 17 revenue cycle specialists, utilizing strong leadership and communication skills.
- Provides support for cross-departmentally for coding and billing questions and guidelines.
- Assisted in introduction and integration of Artificial Intelligence into the entry and billing of claims for 13 Optometry/Ophthalmology clinics with over 140 providers across 5 states.
- Assisted in streamlining communication between referring providers and internal providers as related to co-managed surgical cases.
- Formulates and Executes Key Performance Indicators.
- Reviews Productivity & Quality Reporting
- Manages multiple projects simultaneously and ensured tasks are efficiently completed.
- Performs root cause analysis on denials received from insurance companies or other payers.
- Builds and maintains relationships company-wide with Clinical Operations, Finance, Patient Services, IT as well as fellow RCM departments.
- Ensures compliance with federal and state regulations for health care reimbursement policies are adhered to.
- Develops and implements strategies to improve billing processes, resulting in increased accuracy and efficiency.
- Reviews medical records to assign codes utilizing CPT, ICD-10-CM and HCPCS codes.
- Utilizes Payerpath Knowledge Source to verify accuracy of diagnosis and procedure codes assigned to patient accounts.
- Analyzes documentation to ensure accuracy of codes, modifiers, and units.
- Provides support to patients by addressing complaints quickly and efficiently while displaying exceptional customer service skills.
Manager of RCM Ohio
Midwest Vision Partners
04.2022 - 05.2023
- Managed daily operations of the Accounts Receivables, Payment Posting, Charge Entry and Collections/Customer Service teams handling both professional and Ambulatory Surgical Center billings for 10 ASCs and 13 clinics with over 140 providers total.
- Held Bi-Weekly meetings with each team to review a variety of topics including but not limited to updated coding/billing guidelines, metrics and KPIs on a team basis.
- Held monthly meetings with individual team members to review individual goals, metrics and KPIs and allow an open floor for discussion on a one to one basis.
- Mentored and trained new employees on company policies and procedures.
- Provided support for customers by addressing complaints quickly and efficiently, displaying exceptional customer service skills.
- Assigned, prioritized, and delegated tasks and responsibility to team members as needed.
- Demonstrated leadership in managing teams of up to 40 employees, utilizing effective problem-solving techniques.
- Developed training modules and documentation to train staff.
- Facilitated month-end closing processes and journal entries.
- Performed root cause analysis for denials received from insurance companies or other payers.
- Built and maintained relationships with internal departments such as Clinical Operations and Finance Departments to ensure a smooth workflow.
- Assisted in building the cash reconciliation process to ensure balancing of funds received for our 23 clinics and Ambulatory Surgery Centers took place on a daily basis.
Medical Biller and Coder
Cleveland Eye Clinic - Midwest Vision Partners
03.2017 - 01.2021
- Maintained electronic records of all claims submitted, tracking payments received from insurance companies.
- Reviewed and worked denials including but not limited to: filing appeals, corrected claims or filing a dispute with the payer for receipt of an erroneous denial.
- Verified insurance eligibility and benefits using online resources and contacting payers directly as needed.
- Identified opportunities for improvement in workflow processes related to billing operations.
- Reviewed financial documents including EOBs for accuracy and completeness prior to posting payments in the system.
- Collaborated with clinical staff on a regular basis to obtain necessary documentation for claims processing.
- Processed manual claim forms when applicable and followed up on outstanding items as needed.
- Monitored aging reports regularly and took appropriate action on delinquent accounts.
- Coded patient information accurately into the practice management system according to ICD-10 standards.
- Responded promptly to inquiries from patients, providers, insurance companies, government agencies. regarding billing status.
- Queried provider regarding missing, unclear, or conflicting health record documentation using approved templates.
- Worked in a high-volume medical coding and collections environment to maintain exceptional standards of excellence.
Medical Coder/Biller
NCDS Medical Billing
09.2013 - 03.2017
- Used ICD-10-CM and CPT coding to complete records.
- Utilized coding software to verify accuracy of diagnosis and procedure codes assigned to patient accounts.
- Reviewed medical records to assign codes according to classification systems.
- Analyzed medical documents to ensure accuracy of codes, modifiers, and units.
- Interpreted clinical documentation from providers for accurate assignment of diagnosis codes.
- Prepared and submitted claims to insurance companies and governmental agencies.
- Evaluated documentation to complete diagnosis coding and meet specificity requirements, supporting clinical indicators.
- Maintained a working knowledge of current ICD-10-CM, HCPCS and CPT code sets.
- Queried provider regarding missing, unclear, or conflicting health record documentation using approved templates.
- Worked in a high-volume medical coding and collections environment to maintain exceptional standards of excellence.
- Helped review insurance denials related to diagnosis issues.
- Demonstrated expertise in resolving coding issues and responding to inquiries from healthcare providers.
- Resolved medical coding edits or billing item rejects in relation to code assignment.
Member/Provider Services Representative
Dial America
01.2013 - 09.2013
- UHC Medicare Advantage Plan Contract
- Assisted members with questions including but not limited to transportation benefits, claim denials, EOBs and/or demographic changes.
- Adhered to all established policies, procedures, and regulations when dealing with customers.
- Performed data entry tasks accurately and efficiently to update customer accounts in the system.
- Processed 150 incoming calls from providers and members regarding eligibility or claim related questions.
- Assisted new team members with onboarding and training.
Education
Certification - Medical Office Specialist
Kaplan Career Institute
Brooklyn, Ohio10.2012
Bachelor of Arts (B.A.) - Criminology
Cleveland State University
Cleveland, Ohio12.2011
HS Diploma -
Lincoln-West High School
Cleveland, Ohio06.2006
Skills
- Team leadership
- Excellent Verbal and Written communication
- Relationship building/Networking
- Staff training and development
- Complex Problem-solving
- Cross-functional teamwork
- Project planning
- Policy implementation
- Experience with Federal & Commercial Payers
- Experience with Workers Compensation
- Diagnostic and Procedural Coding
- Previous experience with AllScripts, Athena, IMedicWare, Cerner, ECW, Epic, Practice Fusion, Dr Chrono and OnBase
Certification
AAPC Certified Professional Coder May 2015 -Status: Active
Timeline
Manager of Billing & Coding
Midwest Vision Partners
07.2023 - Current
Manager of RCM Ohio
Midwest Vision Partners
04.2022 - 05.2023
Medical Biller and Coder
Cleveland Eye Clinic - Midwest Vision Partners
03.2017 - 01.2021
Medical Coder/Biller
NCDS Medical Billing
09.2013 - 03.2017
Member/Provider Services Representative
Dial America
01.2013 - 09.2013
Bachelor of Arts (B.A.) - Criminology
Cleveland State University
Certification - Medical Office Specialist
Kaplan Career Institute
HS Diploma -
Lincoln-West High School
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